Sliding Scale Fee & Application

At Rising Hope Counseling, LLC no one will be denied access to services due to  inability to pay; and there is a discounted/sliding fee schedule available based on  family size and income. The sliding fee scale applies to patients without health  insurance. 

Rising Hope Counseling, LLC will base program eligibility on a person’s ability to  pay and will not discriminate on the basis of age, gender, race, sexual orientation,  creed, religion, disability, or national origin. No one is refused service because of  lack of financial means to pay so long as they complete the program requirements  and are found eligible in the application process. 

Be sure to complete Monthly/Annual Expense Worksheet and have your two  most recent tax returns. Further income documentation such as last  two monthly bank statements and the two most recent pay stubs may be  required in some circumstances. 

As mandated by federal rules governing FQHC’s, to qualify for the sliding fee program patients must: 

  • Complete the Sliding Fee Scale Eligibility Application form (includes information  on all household members) 
  • Provide the required proof of income for all household members 
  • Patients cannot receive the sliding fee discount until they have completed all of  the required forms and submitted all of the required documents and have been  enrolled. 

For more information, contact any of our counselors or staff. 

Sliding Scale Fee Policy


Sliding Scale Application


Monthly Expense Worksheet


Sliding Scale Fee Schedule